Ventricular tachycardia in a patient with double valve replacement and bilateral coronary artery fistulas.

A young patient presented with hemodynamic instability due to wide QRS tachycardia occurring about 10 years after double valve replacement. Bilateral coronary artery fistulas draining into the pulmonary artery were documented by invasive coronary angiography as well as by computed tomography imaging. A calcified scar of the posterolateral left ventricle was considered to be the origin of the clinical ventricular tachycardia. Although additional pathological findings are rare in young patients with valvular heart disease, diagnostic imaging of the heart is mandatory prior to cardiac surgery.